REV103984

• Permit No: M1983159
• IBM Index Class Name: Revision
• Doc Name: CONSTRUCTION MATERIALS REGULAR 112 OPERATION RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: CN1
• Media Type: D
• Archive: No

14. Corresoondeoce Information:
APPLICANTlOPERATOR (name, address, and phone of name to be used on permit) /
Contact's Name: TM 4~~nnq~ rynnu/1 Title: ~v.//1p,P „F L~r~,~I
Company Name: fgRrx~B< CnAiS~. l'n ,rn('.
Street:
Ciry:
State:
Zip Code: ~'/y~~
Telephone Number: (4 70 ~ - ~a 7- t/~/f~
•~ Number: 9( 7n ~ -_5,27-OTs ~rrZ1
PERMITTING CONTACT (if different liam applicanUoperator above)
Contaa's Name: Title:
Company Name:
Street:
City:
Stater
Telephone Number:
Fax Nrunber:
INSPECTION CONTACT
Zip Code:
L_~ -
L_~ -
Contact's Name:
Company Name: fNa~/~~ofl / ~/ Title: ~O- dLl~.eP~ ~F (.oi[S~/[[L~ro~
/1rY/F~t ~oi/<TP[[Ltnn /:a 1h~
street: ~7~/~~~~p~ 5'~, ~ ,ley ///S
city: [CtaGd.Lo
State: CIlp1p/] o Zip Code: _ ~~~~/
Telephone Number: (97~ 1- Y? 7` x/.5/6
Fax Number: ( q 701- ~.~17-6.~v~71
CC: STATE OR FEDERAL LANDOWNER (if any]
Agency:
Street:
Ciry:
State:
Telephone Number: ~1-
CC: STATE OR FEDERAL LANDOWNER (if anvl
Agency:
Street:
Ciry:
State:
Zip Code:
Zip Code:
Telephone Number: ( 1-